GDV, also known as twisted stomach or gastric dilatation volvulus, is an emergency condition that requires immediate surgical intervention to reposition abnormally placed stomach and prevent splenic and gastric ischemia.
First, an area of abdominal skin and body wall over the region with greatest tympany is clipped and prepared aseptically for trocharing; subsequently a 14-18 ga over-the-needle catheter is inserted through this trochar to decompress the stomach.
Diagnosis
Gastric volvulus, a rare clinical condition that involves the stomach rotating 180 degrees on either its transverse or longitudinal axes, may occur spontaneously or as the result of hernia, gastro-oesophageal reflux disease, neuromuscular disorders, abdominal tumors or other causes within the abdominal region. Without immediate diagnosis and treatment the prognosis for fatal gastric volvulus rises up to 80% due to strangulation and perforation of its contents.
Gastric volvulus may present as either an acute, life-threatening condition or as an intermittent, episodic problem. Patients may exhibit nonspecific symptoms like bloating, stomach pain after eating and early satiety; or seek medical assistance due to feeling chest tightness or dysphagia. Pain associated with gastric volvulus typically originates in either the epigastrium or left hypochondrium and extends into chest tightness as well as neck/shoulders pain. Patients experiencing gastric torsion can also experience increased cardiac return due to compromised blood supply to stomach/torsion/torsion; patients could experience symptoms like tachycardia/hypertension/shock due to reduced cardiac return as a result of being cut off from proper supply/supply.
Radiographic evidence of gastritis includes a “double bubble” pattern on x-rays that shows an overstretched and rotated stomach caused by excess gas content. Other symptoms may include vomiting, hysterical behavior, hypovolemia (shock caused by reduced blood volume), hepatic necrosis, lactic acidosis and coagulopathy – among many other things.
Treatment for GDV typically entails both initial resuscitation and emergency surgical repair of the stomach. As part of a full gastrectomy procedure, it is crucial to decompress the stomach before surgery to ensure its correct repositioning and prevent devitalized tissues that could require partial gastrectomy. Once surgery has taken place, fluid therapy should continue postoperatively in order to resuscitate patients post-op. Antiemetics to combat nausea and vomiting as well as pain relievers are sometimes necessary, while gastropexy is performed either to treat an episode of GDV directly, or prophylactically in dogs considered at risk for GDV.
Treatment
Bloat is often misunderstood as gas distension without stomach rotation; in actuality it is called gastric dilatation volvulus (GDV). GDV occurs when an animal’s stomach becomes overfilled with gas and twists around its short axis before finally twisting back around into an animal-shaped position on radiographs revealing a dark area near its center.
GDV causes a rapid increase in intra-abdominal pressure and causes blood vessels like the caudal vena cava and abdominal splanchnic veins to collapse, impairing tissue perfusion. Hypotension and shock ensue as severe gastric distension stretches and weakens muscle walls of the stomach which further compromise blood flow, leading to necrosis, serosal hemorrhage and possible necrosis of gastric tissue necrosis as a result. Furthermore, low blood supply increases chances of bacteria translocation which may cause translocation bacterial translocation into surrounding organs leading to infection, potentially leading to septicaemia.
As soon as GDV is suspected, surgical decompression must take place immediately in order to increase blood flow to the fundus and decrease gastric necrosis. This may involve passing an orogastric tube in an awake patient or trocharization if sedated/recumbent patients need sedation/recumbent patients are present; either way it must be done carefully so as to protect airways against aspiration pneumonia.
Once decompression is completed, surgical correction of the stomach’s position should take place to restore its natural position. Furthermore, it is critical to assess necrosis areas within both stomach and spleen to identify areas with increased lactate concentration or large numbers of degenerate neutrophils in abdominal fluid as these indicate poor prognosis.
An effective means to prevent both initial and recurrent episodes of GDV is gastropexy, performed after stabilization has taken place and after aseptic preparation of the abdomen with cranioventral midline approach. Here, the pylorus is adhered permanently to stomach wall in order to stop its rotation; different techniques exist such as simple incisional pexy, circumcostal pexy and belly-loop pexy for this procedure – this may either be part of surgical treatment for GDV or it may be performed prophylactically in animals considered high risk for developing it.
Monitoring
GDV, commonly referred to as “bloat,” occurs when a dog’s stomach distends and rotates, creating the impression of an an inflated and distended mass in their stomach. Unfortunately, GDV can be fatal within minutes if left untreated.
GDV occurs due to twisting of an enlarged, bloated stomach which reduces blood flow between its various regions, eventually leading to shock (Mazzaferro, pages 246-250). Signs of GDV include esophageal reflux, bloating, abdominal pain and vomiting along with bloody peritoneal effusions resulting from decreased circulation (Mazzaferro).
GDV is an extremely rare illness requiring emergency veterinary attention immediately. Diagnosis of GDV involves reviewing history, signalment, clinical signs and radiographs; right lateral and dorsoventral recumbency radiographs provide optimal views that show a “double bubble” pattern on the underside of the stomach where gas accumulation has taken place. For optimal care during recovery period the patient must remain recumbent for several days in a recliner position while monitoring heart, renal, urinary function as well as surgical site wound care procedures; low fat smaller portioned meals may help promote gastric emptying as well.
